Risk factors, clinical characteristics and mortality of candidemia in non-neutropenic, critically ill patients in a tertiary care hospital

Abstract

Aim: In recent years candida species have emerged as important nosocomial pathogens leading to increased mortality and prolonged hospitalization. In this study, we aimed to determine the distribution of Candida species in the intensive care unit (ICU) and to investigate the risk factors and mortality rates in Candida albicans (CA) and non-albicans Candida infections (NAC).
Methods: This retrospective cohort study was conducted between January 2018 and January 2019. 134 patients hospitalized in the intensive care units with Candida reproduction in their blood cultures were included in the study. Blood cultures were processed, and strain distribution was performed according to routine practice using the automated blood culture system BACTEC 9240 (Becton Dickinson, Maryland, USA).
Results: Candida growth was detected in the blood culture of 134 patients, among which 54.5% consisted of CA and 45.5% of NAC. NAC was most commonly followed by C. parapsilosis (17.2%), and C. glabrata (13.4%). Mortality rate of patients aged ≥60 years was significantly higher in all three candida species (P=0.003). NAC was seen at an insignificantly higher rate in patients with solid-organ malignancy (P=0.09). Although mortality was higher in CA than NAC strain (53.6% and 43.4%, respectively), this was not statistically significant (P=0.83).
Conclusion: Although CA is still the most common strain in ICU patients, the incidence of NAC is increasing. Candidemia has high mortality rates in ICU patients. Especially elderly patients with underlying diseases should be followed carefully.

Keywords

• Candida albicans
• Bloodstream infections
• Non-albicans Candida
• Risk assessment
• Mortality

Üçüncü basamak bir hastanede nötropenik olmayan yoğun bakım hastalarında kandidemi risk faktörleri, klinik özellikleri ve mortalitesi

Öz

Amaç: Son yıllarda kandida türleri mortalitenin artmasına ve hastanede kalış süresinin uzamasına neden olan önemli nozokomiyal patojenler olarak ortaya çıkmıştır. Bu çalışmada yoğun bakım ünitesinde yatan hastalarda Candida türlerinin dağılımını belirlemek ve Candida albicans (CA) ve non-albicans Candida (NAC) risk faktörlerini ve mortalite oranlarını belirlemeyi amaçladık.
Yöntemler: Bu retrospektif kohort çalışma, Ocak 2018 ve Aralık 2018 tarihleri arasında gerçekleştirildi.Yoğun bakım ünitelerinde kan kültürlerinde Candida üremesi olan 134 hasta çalışmaya dahil edildi. Kan kültürleri, otomatik kan kültür sistemi BACTEC 9240 (Becton Dickinson, Maryland, ABD) kullanılarak rutin uygulamalara göre işlendi ve tür dağılımı otomatik sistem tarafından gerçekleştirildi.
Bulgular: Toplam 134 hastanın kan kültüründe Candida üremesi saptandı. Bu üremelerin %54,5'i CA ve %45,5'i NAC'den oluşuyordu. NAC'yi en sık %17,2 C. parapsilosis ve %13,4 ile C. glabrata izledi. Her üç tür için de ≥60 yaş yıllık ölüm oranı anlamlı olarak daha yüksekti (P=0,003). Solid organ malignitesi olan hastalarda NAC daha yüksek oranda görüldü, ancak bu istatistiksel olarak anlamlı değildi (P=0,09). CA suşunda mortalite NAC suşundan daha yüksek olmasına rağmen (sırasıyla %53,6 ve %43,4), bu istatistiksel olarak anlamlı değildi (P=0,83).
Sonuç: YBÜ hastalarında CA hala en sık görülen tür olmasına rağmen, NAC insidansı artmaktadır. Yoğun bakım hastalarında kandidemi yüksek mortalite oranlarına sahiptir. Özellikle altta yatan hastalıkları olan yaşlı hastalar dikkatle takip edilmelidir.

Anahtar Kelimeler

• Kan dolaşımı enfeksiyonları
• Candida albicans
• Non-albicans candida
• Risk faktörleri
• Mortalite

Kaynakça

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